“No Noble Thing Can Be Done Without Risk” — Exploring the Dark Side of PCI

As interventional cardiologists, we don’t tend to focus on negatives very often. However, percutaneous coronary intervention comes with a palpable level of imminent and future risk. It is therefore wise to inform the patient of every eventuality. Stent deployment is sadly not some form of “magic bullet” able to restore diffusely diseased arteries back to complete vascular health. I often think PCI should stand for Palliative Coronary Intervention and we should make this clearer to patients.

 I have heard many discussions with patients that appear to paint things in a “rose-tinted” way, with the notes declaring “excellent final results”. When, in reality, results are likely to be sub-optimal due to continued reliance on the angiogram as a panacea.

The aim of this blog is to ensure that we keep our feet on the ground, tell our patients the whole truth and provide a gentle reminder that what we do may not always benefit the patient, but is born out of necessity and a perception that the balance of overall risk lies in our favour.   

Risk Examples

(British Cardiovascular Interventional Society procedure audit 2010)

 

 

Any vascular complication       1.3%

Risk of procedural failure         5-8%

Risk of death (inpatient)            1.2%

Risk of death at 30 days            2%

Risk of CVA                                0.08%

Emergency CABG                     0.08%

Re-PCI                                        0.1–0.18%

Q-wave MI                                  0.08–0.15%

Risk major bleed on DAP*        9%

Death/MI at 4 years                    12%

TLR*                                            4–12%

Stent thrombosis                         0.3–0.6% (per year)

 

 *DAP = Dual Antiplatelet Therapy

*TLR = Target Lesion Revascularisation

 

Dr Scott Murray is a Specialist Registrar in Cardiology and a Clinical Research Fellow at Liverpool Heart and Chest Hospital, U.K He does not expect you to agree with him, but hopes you can post discussion points that will improve on his ideas.

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